Misc Flashcards
Drugs that cause AIN?
NSAIDs, including COX-2 inhib Penicillins and cephalosporins Rifampicin Bactrim Ciprofloxacin Cimetidine (H2 blocker) Allopurinol PPIs (Omeprazole, lansoprazole) Indinavir 5-ASAs (eg. Mesalamine) Anti-cancer drugs, including immune checkpoint inhibitors (Ipilimumab, Nivolumab)
Drug induced thrombotic microangiopathy (DITMA) via immune-mediated mechanism
Quinine - the most common cause of immune-mediated DITMA
ABx: Bactrim, also cipro, metronidazole, mefloquine
Gemcitabine
Oxaliplatin
Quetiapine
Adalimumab
Drug induced thrombotic microangiopathy via non-immune mechanism
Cancer therapies: dose-dependent toxicity
Proteasome inhibitors: Bortezomib, carfilzomib, ixazomib
VEGF inhibitors (well described): Bevacizumab, sunitinib
Haematopoietic cell transplantation
ISx agents: CNI - cyclosporine, tacrolimus, sirolimus
Oxycodone, ecstasy, cocaine
Function of Vit A
Protein synthesis and cell differentiation
Vision
Epithelial tissues and skin health
Supports reproduction and growth
Vit A deficiency
Impaired night vision Xeropthalmia Loss of skin integrity Decreased immune function Painful joints
RF for deficiency:
- Liver disease
- CF (fat malabsorption)
- Anorexia nervosa
- Very low fat diets
Common in developing countries.
Vit D
Bone health
Maintinas Ca and Po4 homeostasis
Vit D deficiency
Osteomalacia (adults)
Rickets (children)
Impaired modulation of immune and neuromuscular systems
RF for deficiency:
- Dark skin, no sun exposure
- Elderly
- Inadequate calcium intake
- Liver disease
- Untreated coeliac, renal disease and other malabsoprtion conditions
- Corticosteroid use
Vit E
Antioxidant in cell membranes
Protects against fatty acid peroxidation
Vit E deficiency
Haemolytic anaemia
Central or peripheral neuropathy, myopathy
Increased atherosclerosis
RF for deficiency:
- CF/fat malabsorption syndromes
- Premature babies
Vit K
Blood coagulation
Activates several clotting factors, including prothrombin
Bone calcification
Vit K deficiency
Bleeding disorders
May cause decreased bone density
RF for deficiency:
CF and other fat malabsorption syndromes
Prolonged abx use
Wernick encephalopathy
Ophthalmoplegia
Ataxia
Confusion
Due to thiamine (vit B1) deficiency
Thiamine (B1)
Metabolism of carbohydrates
Fat and branched-chain amino acids
Vitamin b1 deficiency
Severe lactic acidosis Beriberi with neurological and cardiac effects Wernicke-Korsakoff syndrome Peripheral neuropathy Decreased immune function
RF for deficiency: EtOH Liver disease Malnutrition Bariatric surgery
Pyridoxine (Vit B6)
Synthesis of lipids, neurotransmitters, steroid hormones and haemoglobin
Pyridoxine (Vit B6) deficiency
Anaemic
Peripheral neuropathy
Rash
Depression
RF for Vit B6 deficiency:
Older age
Malnutrition
Vit B12
DNA synthesis
Closely linked with folate; each depends on the other for activation
Vit B12 deficiency
Demyelination of neurones -> leading to peripheral neuropathy, spinal cord damage, optic atrophy and dementia
Impaired RBC function; megaloblastic anaemia
RF for deficiency:
- Autoimmune gastritis (pernicious anaemia)
- Gastrectomy
- Significant small bowel resection, particularly terminal ileal resection
- Bariatric surgery
- Vegan diet
Treatment:
- Hydroxycobalamin 1 mg IM on alternate days for 2 weeks.
Ascorbic acid (vitamin C)
Collagen synthesis
Immune defence
Antioxidant
Absorption of iron
Vit C (ascorbic acid) deficiency
Follicular hyperkeratosis Impaired wound healing Impaired immune function Bleeding gums Anaemia Muscle degeneration Scurvy
Zinc
Cofactor for > 100 enzymes
Stabilises cell membranes and defends against free radicals
Zinc deficiency
Decreased immune function Impaired wound healing Hair loss Impaired taste and appetite Low insulin levels Eczematous skin rash Decreased spermatogenesis Delayed onset of puberty
Amantadine
NMDA receptor antagonist
Dopamine agonist
Apomorphine
Pramipexole
Ropinirole
Rotigotine
Mode of action
Stimulate dopamine receptors; inhibit prolactin secretion; reduce size of prolactinomas; decrease growth hormone concentration in people with acromegaly.
SE:
Gambling, punding, addiction
Indications for valve replacement – AR
Severe AR with symptoms
Severe AR with resting LVEF <50% even if asymptomatic
Severe AR undergoing CABG or surgery of ascending aorta/another valve
Indications for valve replacement – AS
Severe AS with gradient >/= 40 mmHg or peak velocity >4.0 m/s + symptoms
Low flow/low gradient AS (excluding pseudosevere AS) + symptoms
Severe AS undergoing CABG/surgery of ascending aorta or of another valve
Valve replacement – Aortic root dilation
Marfan syndrome with aortic root disease + ascending aortic diameter >/= 50 mm
> /= 45 mm with Marfan + other risk factors
> /=50 mm with bicuspid valve/coarc/other risk factors
> /=55 mm for anyone
Indications for valve replacement –
Mitral regurgitation
Primary MR
Severe MR with symptoms and LVEF >30%
Severe MR, asymptomatic but with LV impairment (LVESD >45 mm or LVEF > 60%)
Consider in asymptomatic with preserved function
Secondary MR
Severe secondary MR undergoing CABG and LVEF >30%
Symptomatic patients with severe secondary MR, LVEF <30% with an option for revascularisation and evidence of myocardial viability.
Mitral stenosis – Indications for valve replacement
Symptomatic patients without unfavourable characteristics
